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Clinical Investigations: SLEEP |

Home Unattended vs Hospital Telemonitored Polysomnography in Suspected Obstructive Sleep Apnea Syndrome*: A Randomized Crossover Trial

Frédéric Gagnadoux, MD; Nathalie Pelletier-Fleury, MD, PhD; Carole Philippe, MD; Dominique Rakotonanahary, MD; Bernard Fleury, MD
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*From the Unité de Sommeil (Drs. Rakotonanahary and Fleury), Service de Pneumologie, Hôpital Saint-Antoine, Paris; Service d’Explorations Fonctionnelles (Dr. Philippe), Hôpital Tenon, Paris; Service de Pneumologie (Dr. Gagnadoux), Hôpital de Versailles, le Chesnay; and Unité INSERM U357 (Dr. Pelletier-Fleury), le Kremlin Bicêtre, France.

Correspondence to: Frédéric Gagnadoux, MD, Unité de Sommeil, Service de Pneumologie, Hôpital Saint-Antoine, 184 rue du fg Saint-Antoine, 75571 Paris Cedex 12, France; e-mail: frederic.gagnadoux@sat.ap-hop-paris.fr



Chest. 2002;121(3):753-758. doi:10.1378/chest.121.3.753
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Study objective: To compare home unattended polysomnography (H-PSG) with polysomnography performed in a local hospital and telemonitored by a sleep laboratory (T-PSG) in the diagnosis of obstructive sleep apnea syndrome (OSAS).

Design: Randomized crossover trial.

Patients: Ninety-nine patients with suspected OSAS who underwent H-PSG and T-PSG on 2 consecutive nights, according to a randomized order.

Measurements: H-PSG and T-PSG were compared in terms of (1) effectiveness, only recordings providing interpretable signals from at least one EEG, the electro-oculograph, the electromyograph, air flow, thoracic or abdominal movements, and arterial oxygen saturation for 180 min of sleep were considered to be effective; (2) patient preference assessed by a questionnaire; and (3) polysomnographic indexes and final interpretative results in patients for whom both recordings were legible.

Results: Recordings were considered to be ineffective in 11.2% of T-PSG (95% confidence interval [CI], 4.9 to 17.4%) and in 23.4% of H-PSG (95% CI, 19.12 to 27.68%). Thermistor problems were the main cause of failure of H-PSG. Forty-one percent of patients preferred H-PSG, and 55% preferred T-PSG. H-PSG and T-PSG did not differ in terms of sleep and respiratory indexes in the 65 patients in whom both recordings were legible. H-PSG and T-PSG were concordant in 58 of 65 patients using a 10-event-per-hour apnea-hypopnea index cutoff value for the diagnosis of OSAS.

Conclusions: T-PSG is clearly superior to H-PSG from a technical point of view and tends to be preferred by patients. The site of recording (home vs hospital) has no influence on polysomnographic indexes.

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